"Reasons" and "justifications" for overeating...do you find those quotes hurtful?

I had a recent exchange with another student (Student X) in my online course. Its a nursing course for my BSN but its a graduate level course. We had to discuss a piece of legislation currently in the process of being reviewed. The bill in question related to nutritional education and childhood obesity. I will post the exact exchange, in different colors to make it clear. ALL names or identifying info will be removed.

For anyone that does not want to read the whole thing, basically she quoted "reasons" and "justifications" for over eating and my response was that this is a negative form of communication that has no place in a nurse's approach. She respectfully disagrees.

If you do want to read the actual exchange, here it is.

This was the first post by student X that I initially found upsetting:

"Thank you for your input on this health issue and that you can appreciate that more diligent education on how to enjoy a healthy lifestyle may have altered your habits of nutritional consumption. You stated it beautifully, that healthy lifestyle is a learned behavior. Just as educating yourself, so that you can attain a respectable job and survive successfully in society, and not just chose to live under a bridge, is a conscious choice that we make in life for a healthy lifestyle. There are certainly other arguments, such as “reasons” or “justifications” for the overeating. As is the case with every other bump in the road, you still are responsible for your own choices"

While I agree with the concept of personally responsibility, I was dismayed by the quoting of "reasons" and "justifications". Here is my reply:
"I believe your initial post was excellent and informative. I think the bill you are discussing is extremely important given the current trends of obesity in both adults and children.

However I am deeply disturbed that as a nurse, you would "quote" the words reasons and justifications for overeating. While there are likely times when over indulging at Thanksgiving dinner or on a rich dessert is no more than failing to say "no more, thank you." There are absolutely people that for them overeating, or binging, is more than just a lack of personal responsibility. Do you feel this way about alcoholics? That they lack personally responsibility for their choice to drink to excess? Or do we all agree as a society that alcoholism is a disease and that alcohol itself is addictive? Arguments have been waged over the physical addiction to food, while others feel there is an emotional component driving those that excessively over eat. And while I don't feel that either of these possibilities means that a person should label themselves a victim destine to be obese for their entire life, I do believe as healthcare professionals we should not ever put "quotes" around the words reasons or justifications, thereby discrediting and dismissing those reasons and justifications. We do a great disservice to our patients, and close our minds to learning what the reasons might be behind their health challenges.

I hope I haven't been too harsh, but I found this very upsetting."

Maybe I was over reacting? That's very possible. But I was really upset by this. I do not see anything positive about quoting those words.
Here is student X's reply:

"It was not my intention to insult you, as I never speak off the top of my head or spit out my opinion unless I am backed by personal experience and/or peer- reviewed, scholarly articles to defend my position. The words chosen to express myself were very carefully chosen, as these are the descriptions used by a clinical psychologist that I work with as a DYFS foster parent. These choice words were not chosen to attack a particular population of people, but rather to be very precise as to how they perceive their situation. I did move on to state that most of the time there is, most certainly, an underlying issue that generates such behavior, whether it be physical, sexual, mental abuse or neglect. All these behaviors, with therapy, have the potential to be corrected. With regard to alcoholism and drug addiction, it is the exact same situation—most of the time there is an underlying issue that has brought them to destitution; however, it is their personal choice to stop the behavior. These are the findings from the founder of Alcoholics Anonymous, Bill Wilson. He also, was termed a hopeless alcoholic. His program of recovery has been helping millions of people find sobriety and serenity. This fellowship is known as Alcoholics Anonymous, and the key to maintaining sobriety is helping other alcoholics. There are millions of alcoholics that would agree that it was their own personal choice made when they decided to turn their life around.

I was not discrediting or dismissing their comments regarding their behavior. Actually, I was extremely focused on examining their choice of words because I feel there is such a great need to understand the reason for such behavior. Having experienced the depths of **** from drug addiction and alcoholism by a close family member, I definitely don’t have a closed mind to this particular subject matter. I am actually extremely sensitive and empathetic to the **** they live in on a daily basis and will probably spend the rest of my nursing career trying to help this diseased population with their challenges. Thank you for your honesty and the opportunity for me to clarify."

I really read this reply as a cold nurse, that thinks she knows the struggle of her patient by reading about it in a book. I replied but phrased it a little more professionally. This is a class after all. My reply which I posted this morning:

"I appreciate your opinion and point of view. I understand that your experience has helped to you to try to understand what this struggle is like, however I do stand firmly by quoting those words is not a positive gesture.

I am being very vulnerable here to support my point by saying that I have struggled with an eating disorder since my mid teens, and now in my 30s I still deal with it daily. I was obese as a child. My parents were quite uninvolved in my health, and young and uneducated themselves. Yes, I was also abused as a child, and I suspect this was a driving force in my initial overeating at a young age.

However I wanted to lose weight as I entered my teens and my solution was to starve myself and obsessively exercise. I did attempt to purge but could never bring myself to do it, which only reinforced feelings of failure. I would go days without eating, and as I got older I perfected it quite nicely and could go much longer. I also started abusing laxatives. My weakness however was that after weeks of eating nothing, or sometimes allowing a max of 100-200 cals a day because I was simply so weak, I would eventually binge. At the time, I didn't understand that this was due to lack of nutrition and my body's way of making me eat. I'd feel like a failure and would start staving again with even greater resolve.

My starving was never "good enough" and my overeating was "too often". I often maintained a weight just at the border of healthy / over weight BMI. I have the behaviors of anorexics, I still do, but you would never know it by my weight. I just simply could not starve off more weight than I could put on when I failed and overate. I'm sure there were (and maybe still are) some metabolic issues as a result of over a decade of this erratic eating pattern.

Your sentence brings shame and feelings of failure to those living it. When you quote those words you are in fact dismissing and discrediting those "reasons" and "justifications". That sentence, the way it is written, has a lot of power. I am grateful to have read it now, where I am at emotionally in recovery, and not even 5 years ago. Because I would have agreed with you at that time, that while I had my "reasons" and "justifications" for overeating, I would have felt shameful that a professional was reinforcing it was a personal choice that I was unable to control my eating habits and I was a failure for not being able to do so.

When I entered nursing school in my mid 20s. I began to learn more about what I was doing to myself. However, all the knowledge in the world could not stop the starving which ultimately lead to the overeating. For several years I felt if I could just control the over eating, I would be fine. I remember reading that to stop the overeating, I had to address the not eating first.

However, sentences like yours made that difficult. The messages I received were that under eating was not my fault, but over eating was lack of personal responsibility. Reasons and justifications were never quoted when it came to my starving. All the obsessing, the calorie counting, tricks and tips to let others think I ate when I didn't; my reasons were valid, I didn't want to be fat. Fat is bad. When it came to over eating, the message was entirely different. I had "reasons" and "justifications", but ultimately it was my fault. I was weak and a failure. Would be fat forever because I couldn't take personal responsibility.

I have been working on not under eating for about 4 years now. And some days are ok while others its hard to eat. I wont get into the personal **** its been for the past 15 years, but I do hope someday to be fully recovered. I did seek therapy, but its not at cut and dry as you make it sound. I can say when I am successful for a period with not starving, I also stop over eating and my weight stables out to a healthy BMI. You might think its easy knowing that. If I just eat normally, I'll actually not be fat, but the habits and guilt when I eat, its very paralyzing at times. I still gravitate towards my safe foods, a list that I have had difficultly straying from for over a decade. When I am under extreme stress, my behaviors return full force. Its just not as easy as personal responsibility, the choice to recover and therapy to make it all better.

It just seems to me you are approaching this with a lot of work experience, facts from books, articles and professionals in the field. However, I'm approaching this from a first hand experience. No amount of education will substitute or surpass for that. I'm hopefully giving you some insight that quoting those words and matter of factually talking about how recovery should go can sound cold or offensive to those going through it.

I absolutely believe that ultimately we must all take responsibility for our actions and I am not supporter of excuses by any means. However, I think you are too much allowing your formal education to drive your thoughts on this. It does not sound to me, despite your family experience, that you are not truly understanding of what you patients are going through. Again, I could be very wrong. I think much is lost in text, and perhaps you have a presence that allows you patients to feel heard and at ease. However this is not what's being conveyed at this time, at least in my opinion.

Again, I do not mean this to be hurtful for harsh. I am trying to offer this as some guiding advice not from a fellow nursing student, but from a person that could be your patient.

I apologize if I interpreted your post wrong. Lacking facial expression and vocal tone, I absolutely could be reading this incorrectly. I do wish you the best in your practice. I know that I'm saying this in a college course, however I am a firm believer that sometimes we need to step away from the books and research and simply listen to our patients and walk in their shoes."

So I don't know if I was wrong. I am comfortable with sharing my struggle with the class. I feel personal experience is important in understanding patient's point of view. I really took from this poster that she just doesn't get it, but thinks she does because she read about it.

Does quoting those words send a negative message? Or do the quotes only emphasize personally responsibility? I think personally responsibility can be encouraged, but quoting those words is not the way to do it.

I don't know... they make it hard to tell who she is directing it at. I took it a different way, seeing it as a calories in - calories out argument and the quotes were against those who manage weight without calorie counting. I think quotation marks make it seem like an attack on someone, and as you read, you try to think who that someone could be.

It would be better if she wrote what the reasons and justifications are. No one binges for a logical reason or justification. It is the body responding to the type or amount of food you are eating... I find it really hard to blame the person binging. It's a natural response that gets shamed by the public. What we need to look at is the underlying cause.

None of what she was saying came off as rude or cold to me, people do make excuses for bad habits whether it's food or too much alcohol. I think maybe you were taking it too personal because it hits close to home. Her inital post was giving you major props for changing your lifestyle.

Some people never decide to make the change.

ETA: I used to be an alcoholic so I understand what goes on emotionally during a binge. I just preferred booze over food.

I agree that perhaps one could find the quotations offensive. However, reading the person's follow up responses to you, I do not believe she meant any harm. Quite the opposite, I see that this person will be a supportive nurse. Hearing about your background, I can see why you reacted so strongly though. As a student, I found these types of experiences valuable to recognize where my own issues (we all have them!) might potentially intersect with my work with clients.

Thank you all. Just to clarify she did not know anything about me when this discussion started. That actually upset because I have been in situations many times with nurses that assume that I am not like the patient in question (eating disorder, poor, etc) before judging them. I felt like she felt safe among professionals saying that patients have their "reasons" but ultimately its their fault. I believe in front of a patient she would not deliver it that way. I felt like I was getting a little unfiltered look at what she really thinks, and yes it stung. I felt that quoting those words gave it entirely different message, and not a positive one. When we quote word in writing, in the way this person did, it is done to discredit the word.

Example: I'm sure she had reasons for not finishing her class.
I'm sure she had "reasons" for not finishing her class.

The quoted one discredits those reasons before they are even given.

Also to clarify we are all nurses already, these are upper level courses, but most of use have been practicing for many years.

Most everyone said they were offended by the quotes, but the follow up was respectful, that's kind of the point right? Quoting those words was wrong, and she shouldn't do it again because it can feel like an attack on a person or group of people.

It's like telling someone they think "sub-category-group-of people are so blah." Then following up with some sort of "Oh... I didn't mean it that way, I'm just saying historically.... blah" Damage was done, you all ready judged me for being in that group of people and now I know how you really fill. Jerk face...

I also agree with her that we do need to take personal responsibility before we can move forward. No matter what your situation is, you need to realize it's your situation. I have a sister that is depressed, I can't do anything for that (boy have I tried). She needs to take responsibility and want to change. But I also know it's not that easy, and wouldn't EVER discredit her reasons for being depressed. That's a step back, not forward.

It would be offensive to say something like: People can't get a job in this economy no matter their "reasons" or "excuses" for being unable to do it. When really, it's as simple as applying and getting hired... it's actually not. There are soooooooooo many factors for not being employed it's outstanding. If I were unemployed and someone said that, I would feel offended and instantly want to yell at them and tell them about my "reasons" and my "excuses" for such a thing!

If they started with: "First, people need to take responsibility and realize they need to find a job, so they must try. Only they can take that first step and seek out help (unemployment offices, schools, etc) where needed, will they find themselves with employment." Then it's not offensive, it's just a statement that's true. But to quote "reasons" for not having one...well... that stings.

It's like trying to tell your family that has polar opposite views than you why something is your opinion, but starting with an insult. It's also seems to be a lack of understanding of what that person is going through or why they feel the way they do. In fact, quotations sort of mock my "reasons" and "justifications" for over eating. It's very hard for people to listen to someone after you arouse anger in them.

It's more about "Don't start telling your patients in a mocking way about their "Reasons" and "justifications" for weight gain. Just come from a place of understanding first and realize that their reasons and justification for weight gain is very personal. You can't help them, until you understand that, and they won't open up in anyway if they think you are looking down on them."

__________________
I've decided to leave 3FC, In the crowd of so many, those of us with no success that have the audacity to feel bad about our incredibly slow and almost stagnate weight loss, are merely a nuisance to those that are successful. I hope everyone else finds the support they need.

I haven't read the whole thread. I am not a health care professional. I have too many opinions about everything. LOL. Usually, I mean well. I am sure I will offend someone, and I apologize in advance, BUT I think your correspondent is full of [email protected]!#. People who really know what they are talking about don't write in such an obfuscatory manner. She has an agenda.

Please understand that I am not picking on anyone who shared on this thread. None of you are pretending to be hyper academic experts on anything.

"reasons" and "justifications" are really other words for perceived obstacles. I think that there ARE negative undertones to "reasons and justifications" and not just in quotes either.

When people don't want to give up a certain food, for instance, the "justification" is that if they restrict themselves from food they love they will fail and binge. If we examine that there are several underlying OBSTACLES that are encompassed in that one phrase.

Obstacle 1: The first is that most foods that fall in the can't live without category are processed and high in carbs, sodium, and sugar are addictive. They actually can trigger you to over eat.

Obstacle 2: The solutions to obstacle 1 are portioning or eliminating those foods. In other words the solution is some form of restriction.

Obstacle 3: Restriction is the emotional equivalent to deprivation.

Obstacle 4: In circular fashion when we are feeling deprived of something we often want it more. See obstacle #1.

We encounter these obstacles mentally, before we even take action. We know going in that it will be hard. Which is both a blessing and a curse. Obstacles are not beaten by will power, they are beaten by planning and preparation and support. If you do that the need to rely on "will power" lessens.

It really is all about changing our mental and emotional relationship with food. How many people will tell you that it becomes easier as you go along? That's because it does. Your mindset changes. Your body is no longer addicted to food. You no longer feel deprived.

Anywaaaaays, yeah, there are unnatural correlations between "willpower" and "reasons and justifications" that are only negative and serve to derail attempts at healthy weightloss.

Who ever this person is really set me off! I would have felt the same way you did; that you were getting a glimpse of the real person who thought she was among a group of people who shared her outlook.

My personal example of this kind of thing is that I belong to a mainstream political party which is very much in the minority in my particular area. People will say the most awful things about my preferred candidates, philosophy etc because they assume I am going to agree with them. It really does give insight about what kind of people these folks are.

Finally, I have learned from this little interchange that I need to be careful about how I use quotes. It makes a difference, especially as you say, when you can't actually see the other person, hear the tone of voice etc.

I think you were justified in saying that by putting the quotes ("") around certain words, you imply that the quoted words aren't as valued as the same word non-quoted. Your example was a perfect -- when writing a sentence and using the quotes around "reason" for X, it's very different than if I just write it without the quotes.

I think you were correct in questioning her use of the quotes.

I don't think she was disrespectful in the rest of the exchange with you, but I do think that you took the conversation to a personal level, which then probably unbalances her argument -- at that point, she has to face the real reasons/justifications from a personal standpoint (a real person she's interacting with) rather than perceived/overhead "reasons/justifications" for someone to overeat/be overweight/obese.

I think there's a number of underlying levels here that you have to discuss in class.

And I'm sure there's more. So, the "reasons/justifications" that she is indignant about are much more complex and while we here at 3FC can see that (as we read/experience it ourselves), she may not have any knowledge about how complex the weight/nutrition/health situation is.

There is a difference in how one approaches matters from a understanding of the topic and how one might interact with a patient.

From a purely understanding the patient I don't have a problem with what she said in particular because her respoonse she notes that there was more to the original quote than you gave us. Context matters.

There is a difference in how one approaches matters from a understanding of the topic and how one might interact with a patient.

From a purely understanding the patient I don't have a problem with what she said in particular because her respoonse she notes that there was more to the original quote than you gave us. Context matters.

I don't understand what this means. There are some references to the original post, which was a presentation of legislation, but no personal opinions were given. There was another student that talked about how she struggled with obesity. There was no more to her quote than I gave you so I'm not sure why you said that???

I too have issue with the quotes. I think people underestimate food addiction and they're still compelled to blame the person who suffers from the addiction (although I don't believe all overweight people are food addicts). I'm doing a 12 step program (OA) and we use a lot of literature from AA to guide/help us remain abstinent from the foods that we're addicted to....and it totally works for many of us. Society just can't accept this concept and even many people here don't believe there's such a thing as food addiction. Why? Because they don't have it or don't accept that they are powerless over certain foods.

I know some people who are very self disciplined and accomplished and yet their eating is completely out of control and ruining their health and lives. It's not always a matter of will power or self discipline.

Sorry, I couldn't help myself, but this is a sensitive topic for me as well. I'm glad you had those exchanges with her because she's much more likely to approach patients with greater understanding of their situation. Textbooks and studies don't always have the same impact as a story from the heart. You were very brave to share your experience.